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Sound Therapy International aims to raise world wide awareness so that all associated specialties and professions will include Sound Therapy in their recommendations. A summary of the science of the Tomatis method and ongoing sound therapy research is given here, references included.

Background on Sound Therapy Research

In the 1940s Dr Tomatis, a Paris based ear, nose and throat specialist conducted clinical trials with singers, aeroplane mechanics and others to determine how their hearing was affected and whether it could be improved.

He went on to develop a method of treatment which addresses hearing and listening from both the physical and the psychological aspects. Through his experiments he also discovered that high frequency sounds, softly played stimulate and replenish brain energy, and are in fact essential for optimum functioning of the cortex.

The Tomatis Method

As his initial concern was with hearing loss, Tomatis’ first experiments dealt with altering the auditory curve.

When there is loss of hearing in a particular frequency it is generally not a total loss – it just means that those frequencies where there is a scotoma are heard at a lower level. Tomatis designed an apparatus called the Electronic Ear, which could manipulate the frequencies of sounds, so it could match a sound to the person’s auditory curve, or it could do the opposite. It could boost the deficient frequencies to make the person hear as a normal ear would hear.

Initially Tomatis worked with singers who had lost certain frequencies from their voices. He found that the dead spots in the voice exactly matched the dead spots on the audiogram, and by correcting the hearing with the Electronic Ear he could restore the missing frequencies to the voice.

Thus he formed his first law: “The voice contains only those sounds that the ear can hear.” This discovery was given official recognition in 1957 by the French Academy of Science as the “Tomatis Effect.” In 1958 Tomatis’ invention, the Electronic Ear won a gold medal for scientific research at the Brussels International Exposition.

The Self Help Method

Patricia Joudry, a Canadian author, underwent the Tomatis treatment in the late 1970s and experienced total relief of her chronic insomnia, exhaustion, writers block and the listening disorder for which she was first referred to the treatment. This is known as “The Cocktail Effect”, which is the inability to discriminate between different sounds in a noisy environment.

Patricia and her daughter, Rafaele Joudry, then released the self help Sound Therapy audio program along with their book: Sound Therapy: Music to Recharge your Brain. Rafaele has since published two further books entitled Triumph Over Tinnitus and Why Aren’t I learning?

Research Results

In the last few decades there have been numerous controlled studies, surveys, clinical experiments and case histories, which confirm the benefits of the Tomatis method for a variety of conditions. A summary of these sound therapy research studies follows.

Tinnitus, hearing and associated problems

Jordan (1989) treated between two and three hundred people who had been seen by an ENT specialist and told that nothing could be done for their tinnitus. He undertook a clinical study and reported that for the majority of patients Sound Therapy alleviated their tinnitus to the point where they were able to enjoy life a lot more. Some of the younger patients achieved total remission and as they were not on any medication there were no apparent contributing factors other than the Sound Therapy. A number of Jordan’s patients also reported an improvement in their hearing.

Joudry, (1994) conducted a three year survey of 388 respondents where 45% to 100% of subjects showed symptomatic improvement in tinnitus, hearing loss, stress, fatigue, sleep problems, learning difficulties, speech problems, depression, headaches, jet lag and general well being. 93% of subjects observed some positive results in at least one area.

Reading and behaviour

Sandislands (1989) Compared 32 underachieving children with a control group of 40. The treated group showed greater improvements in listening, oral reading and behaviour.

Rintel and Rintel (1995) conducted a study in Brisbane in 1995 using the Joudry Sound Therapy program on children in a remedial learning program. An experimental and a control group were used, each consisting of seven children. Five normed tests were administrated to the children. The general trend was that the experimental group advanced faster than the control group in Distractibility, Overactive behaviour, Reading improvement, Left/right confusion and Misinterpretation of questions.

Bell, (1991) ran a case study using the Joudry program on a Year 2 boy with delayed development who showed improved social behaviour and began to read.

Voice

Weiss (1985) found that three theatre students after seven months of Sound Therapy showed a shift of vocal energy to the higher frequencies and better articulation.

Language disorders

Wilson (1982) found pre-school language disordered children showed statistically significant improvement in their ability to express thoughts and feelings in words. The study gives a strong indication that the Tomatis approach is useful when used with pre-school learning disabled children.

Van Wyk, (1974) compared 20 stutterers with 20 normal speakers and found that more stutterers have left ear dominance, confirming Tomatis’ hypothesis of the importance of right auditory laterality.

Badenhorst (1975) found that right-eared people communicate more easily, confirming Dr Tomatis’ theory of right ear dominance.

Jaarsveld (1974) found in a group of 43 stutterers, 82% got significant relief from the treatment and 54% retained the improvement for a year or more.

Self Concept

Gilmor (1982) Found improvement in children and adolescents’ self concept, social and family relations and certain language and motor skills.

IQ

Rourke and Russel (1982) compared experimental and control groups and found improvement in IQ of learning disabled children under Tomatis treatment.

Dyslexia

Roy and Roy (1980) examined the effect of the Tomatis method on five dyslexic boys and showed improved cognitive control and audio-vocal control in four of the subjects.

Anxiety and depression

Peche (1975) studied a group of 10 students and found that Sound Therapy helps to alleviate anxiety and remove psychic blocks, indicating its benefits in conjunction with psychotherapy.

Botes (1979) found improved relationships and self-concept in an in depth study of three clients with neurotic depression.

Du Plesis (1982) in a long term study over 14 months with subjects carefully selected from a survey of 424 people, showed improved mental health and self actualization for both 10 anxious and 10 non anxious people as compared to a control group.

Intellectual disability

De Bruto (1983) found a statistically significant increase in the mental age of profoundly retarded children after Tomatis treatment.

REFERENCES

Bell, E. An Ethnographic Report and Evaluation of the Implementation of Audio­Psycho-Phonology (Sound Therapy) in the Support of Timothy. Griffith University Thesis (unpub.) 1991.

The Tomatis method is the foundation for numerous offshoots of sound therapy programs based on Tomatis’s discoveries. There is substantial evidence for the efficacy of the Tomatis method, with studies on a wide variety of health conditions producing a differing range of results that have been interpreted as either positive or neutral.

Tomatis reported in his autobiography on his efforts to collaborate with researchers. Though the methods used in some studies did not succeed in highlighting the positive results observed by clinical practitioners, Tomatis argued this was due to the design of the studies and individual variances. (Tomatis Conscious Ear)

In the last few decades there have been numerous controlled studies, surveys, clinical experiments and case histories, many of which confirm the benefits of the Tomatis method for a variety of conditions. A summary of these studies follows.

Reading, behavior and learning

Sandislands (1989) Compared 32 underachieving children with a control group of 40. The treated group showed greater improvements in listening, oral reading and behaviour.

Kershner et al (1990) undertook a 2 year study of 26 students with a control group using an auditory placebo. As improvements were found in both groups, researchers concluded that there was a lack of support for the educational efficacy of the Tomatis Program for learning disabled children.

Gilmor’s meta analysis (1999) covering four smaller studies of the Tomatis method, including Kershner’s work, found that “Positive effects sizes were found for each of the five behavioral domains analyzed”

Voice

Weiss (1985) found that three theatre students after seven months of Sound Therapy showed a shift of vocal energy to the higher frequencies and better articulation.

Language disorders

Van Wyk, (1974) compared 20 stutterers with 20 normal speakers and found that more stutterers have left ear dominance, confirming Tomatis’ hypothesis of the importance of right auditory laterality.

Jaarsveld (1974) found in a group of 43 stutterers, 82% got significant relief from the treatment and 54% retained the improvement for a year or more.

Badenhorst (1975) found that right-eared people communicate more easily, confirming Dr Tomatis’ theory of right ear dominance. Wilson (1982) found pre-school language disordered children showed statistically significant improvement in their ability to express thoughts and feelings in words. The study gives a strong indication that the Tomatis approach is useful when used with pre-school learning disabled children.

Swain (2007) studied the effects of the Tomatis Method on 41 subjects from age 4 to age 19 with auditory processing disorders. Standardized tests were used pre and post treatment. All subjects demonstrated statistically significant improvement with skills of immediate auditory memory, auditory sequencing, interpretation of directions, auditory discrimination and auditory cohesion. Researchers concluded that the Tomatis Method can be effective as an intervention strategy for auditory processing disorders. http://www.thelisteningcenter.net/research.php

Self Concept

Gilmor (1982) Found improvement in children and adolescents’ self concept, social and family relations and certain language and motor skills.

IQ

Rourke and Russel (1982) compared experimental and control groups and found improvement in IQ of learning disabled children under Tomatis treatment.

Dyslexia

Roy and Roy (1980) examined the effect of the Tomatis method on five dyslexic boys and showed improved cognitive control and audio-vocal control in four of the subjects.

Intellectual disability

De Bruto (1983) found a statistically significant increase in the mental age of profoundly disabled children after Tomatis treatment.

Autism

A study was undertaken by the University of California on autistic children using the Tomatis sound therapy, its findings were published in 2007. The method used was randomized, double-blind, placebo-controlled, crossover design. The study showed that there was improvement in the children, however it did not appear to be related to the treatment. The children that were given the placebo showed a higher percentage of improvement over those given the Tomatis treatment. The study concluded there was no improvement in language using the Tomatis Method.

Anxiety and depression

Peche (1975) studied a group of 10 students and found that Sound Therapy helps to alleviate anxiety and remove psychic blocks, indicating its benefits in conjunction with psychotherapy.

Botes (1979) found improved relationships and self-concept in an in depth study of three clients with neurotic depression.

Du Plesis (1982) in a long term study over 14 months with subjects carefully selected from a survey of 424 people, showed improved mental health and self actualization for both 10 anxious and 10 non anxious people as compared to a control group.

REFERENCES

Tomatis, A.A. The Conscious Ear. Station Hill Press. New York, 1991.

Sandislands, M. The Tomatis Listening Training Program: A Quasi-Experimental Field Evaluation, International Journal of Special Education 1989

In the 1940s Dr Tomatis, a Paris based ear, nose and throat specialist conducted clinical trials with singers, aeroplane mechanics and others to determine how their hearing was affected and whether it could be improved.

He went on to develop a method of treatment which addresses hearing and listening from both the physical and the psychological aspects. Through his experiments he also discovered that high frequency sounds, softly played stimulate and replenish brain energy, and are in fact essential for optimum functioning of the cortex.

Sound therapy research continues today all over the world. There is simply too much material to cover at once, so the following list is just a small collection of useful and insightful articles on the topic.

You can keep up to date on sound therapy research by visiting this site periodically, as we like to post on important findings in the field. Academic journals, search engines and social media forums on the topic are also good places to look.

The purpose of this paper is to present a critical review of the literature as it relates to the alternative approaches to hearing health through an overview and history of the theories of Dr. Alfred Tomatis, MD and present views toward antioxidant supplements. This review will attempt to explain these views as related to the afferent and efferent auditory neurological pathways and to explain how oxidative stress to the auditory system can be alleviated.

PART 1 A Historical Review of the work of Dr Tomatis and Supporting Literature By Rafaele Joudry BSW

Overview of Dr Tomatis’s work In the 1940s Dr Tomatis, a Paris based ear, nose and throat specialist conducted clinical trials with singers, aeroplane mechanics and others to determine how their hearing was affected and whether it could be improved.

He went on to develop a method of treatment which addresses hearing and listening from both the physical and the psychological aspects. His work was applied most extensively to children with learning disorders and in language learning centres. Extensive anecdotal data and survey results indicate improvement for certain hearing disorders. Through his experiments Tomatis also discovered that high frequency sounds, softly played stimulate and replenish brain energy. He believed that a regular dose of high frequency sound is essential for optimum functioning of the cortex. His method also appears to assist cerebellar integration, leading to improvement in numerous neurological disorders.

Tomatis’s research On completing his ENT studies Tomatis set up his own research rooms and started amassing clinical data on audiometric tests. He focused on aeroplane mechanics, many of whom had worked in highly detrimental sound environments during the war. After testing in several different situations, Tomatis noticed inconsistencies in results for hearing tests depending on the subjects’ anticipation of the effect of hearing loss on their career or possible pensions.

This inspired him to investigate the psychological aspect of hearing. So began the development of Tomatis’ ideas on the wholistic nature of language as it represents our evolving consciousness within our environment. He was inspired by the work of Negus who determined that ducklings could recognise the sound of their mother’s voice at birth, and from this deduced the fact that much of our neurology for language comprehension is laid down while still in utero.

Dr Agatha Sidlauskas, a psychologist and long time proponent of Tomatis’s work has perhaps the best overall grasp of how the intricate physical involvement of he ear in the entire nervous system implicates its profound role at more psychic levels of our being. “The integration of the ear with the rest of the organism means that to be able to speak one must be able to control posture, to direct his gaze, to be sure of inner dynamics and be capable of hearing sound and to analyze its intake.”

Meanwhile Tomatis had begun working with singers. He subjected the singers to audiometric tests, the same that he had been administering to those people with occupational deafness and noticed a surprising similarity in the audiometric curves. Could it be, he asked, that the singers had deafened themselves with their own loud voices? By measuring the intensity of their voices with a sonometer, he established that powerful singers could reach 130 or 140 decibels, certainly enough to cause deafness with continued exposure! Especially since 130 decibels at a metre’s distance represents 150 decibels inside ones skull!

Tomatis now began to investigate and compare the size of larynxes vis à vis the voice structure against the shape of the audiogram in relation to the voice. He had to conclude from the evidence he gathered that the voice was controlled not by the larynx but by the ear. He was able to verify from his test results that a scotoma in the audiogram exactly matches the same loss of frequencies in the voice. Thus in 1947 Tomatis came to the formulation of his first law: “The voice only contains those frequencies that the ear can hear.”

Tomatis’s next major discovery was that self listening and voice production is controlled by the right ear. This is because the passage of nerve impulses connecting the ear to the larynx and to the cranium is more direct on the right side of the body. The recurrent laryngeal nerves [belonging to the tenth pair of cranial nerves, the vagus] have to cover a longer route on the left side for two reasons. One is that they have to go around the heart. The other is that the central laryngeal motor area is situated in the left brain. In other words, our main speech centre is in the left brain, and this is most directly reached via the right ear.

This means that the right ear has the more efficient route on two counts: for language reception and vocal production. Therefore it must direct. Tomatis says categorically that all great singers and musicians are right-ear dominant. He also states, and other learning specialists confirm his findings, that it is a requirement for efficient processing of language for any person that the right ear must lead. We function more efficiently if the right ear directs our listening.

During this period, Tomatis was developing the device which he eventually called the Electronic Ear. This machine had the capacity to feed back the subject’s voice with the frequencies altered so that they could hear themselves in the correct way. Thus their ear was reconditioned to accurate hearing, and the voice was also corrected. Later Tomatis found that he could achieve the same result by playing music, mainly Mozart, through the Electronic Ear. He found that provided the subject experienced these altered sounds repeatedly for a certain period of time, the effects would last. In later years Tomatis trained many different practitioners to use his method and so it became available in about two hundred centres around the world, in addition to his centre in Paris.

Distinctions awarded to Tomatis as recognition of his early work were as follows: Chavalier of public health 1951; International Scientific Research Gold Medal at the Brussels World Fair [1959] awarded for the Tomatis Effect Electronic Ear; International Scientific Research Bronze Medal at the Brussels World Fair [1959] for the Tomatis Automatic Audiometer; Grande Medaille de Vermail of the City of Paris [1962]; Clemence Isaure Prize. March 1967; Arts, Science and Literature Gold medal. April 1968.

Clinical Studies Recent brain research by Ted Carrick, an important pioneer in the field of chiropractic neurology, indicates that rather than simply psychological factors, brain function and in particular cerebellar integration, determine the essential listening and attending component needed to complete the act of hearing, particularly the ability to focus ones hearing in the face of other sensory inputs, distractions and background noise. In the last few decades there have been numerous controlled studies, clinical experiments and case histories, primarily in Canada, South Africa and Australia, which confirm benefits of the Tomatis method for a variety of conditions. These have been done firstly on the clinical Tomatis treatment and more recently on the portable treatment developed by Patricia and Rafaele Joudry. A brief summary of these studies follows.

Canada The Canadian studies focussed primarily on language and learning abilities, demonstrating measurable changes on a variety of indicators. Under-achieving children performed better when compared against control groups according to objective tests and observations by parents and teachers. Sandislands and Lethbridge, [Sandislands 1989 ] compared 32 underachieving children with a control group of 40. The treated group showed greater improvements in listening, oral reading and behaviour. Likewise, Wilson [Wilson, 1982 ] found that a group of pre-school language disordered children showed statistically significant improvement in their ability to express thoughts and feelings in words after Tomatis therapy.

Gilmor [Gilmor, 1982 ] found improvement in children and adolescents’ self concept, social and family relations and certain language and motor skills.

Rourke and Russel [Rourke and Russel 1982 ] compared experimental and control groups and found improvement in IQ of learning disabled children under Tomatis treatment.

Two doctoral theses on the effect of the Tomatis method on five dyslexic boys showed improved cognitive control and audio-vocal control in four of the subjects. [Roy and Roy,1980 ] Weiss [Weiss, 1985 ] showed a shift of vocal energy to the higher frequencies and better articulation in theatre students after Sound Therapy.

South Africa Van Wyk, compared 20 stutterers with 20 normal speakers and found that more stutterers have left ear dominance, confirming Tomatis’ hypothesis of the importance of right auditory laterality. [Van Wyk, 1974 ] This was also confirmed by Badenhorst, who found that right eared people communicate more easily. [Badenhorst 1975 ]

Jaarsveld [Jaarsveld 1974 ] treated a group of 43 stutterers, in which 82% got significant relief from the treatment, and 54% retained the improvement for a year or more.

Peche, treated a group of 10 students and found that Sound Therapy helped to alleviate anxiety and remove psychic blocks. He concluded that it is beneficial in conjunction with psychotherapy. [Peche 1975 ] Botes found improved relationships and self concept in an in depth study of three clients with neurotic depression when treated with Tomatis therapy. [Botes, 1979 ]

A long term study by Du Plesis over 14 months with subjects carefully chosen from a survey of 424 people showed improved mental health and self actualization for both 10 anxious and 10 non anxious people who had Tomatis treatment, as compared to a control group. [Du Plesis 1982 ]

De Bruto, [De Bruto 1983 ] found a statistically significant increase in the mental age of profoundly retarded children after Tomatis treatment.

The following studies were done using Joudry’s portable program of the Tomatis treatment method. U.K.

The audiometrician, Eric Jordan, trialled the Sound Therapy tapes on an unspecified number of subjects and claimed he found that 90% of tinnitus sufferers got some relief as a result of Joudry Sound Therapy tapes.

Australia Special education teacher, Elizabeth Rintel, used Joudry tapes for learning disabled children and found they advanced faster in reading, spelling and auditory discrimination compared to a control group. [Rintel, 1995. ] Sound Therapy Australia [Joudry 1994. ] undertook a three year survey of 388 respondents which showed 45% to 100% symptomatic improvement in subjects. The percentage who reported a positive outcome for each condition was as follows: tinnitus, 84%; hearing loss, 56%; stress, 86%; fatigue, 84%; sleep problems, 75%; communication, 78%; learning difficulties, 85%; speech problems, 64%; depression, 100%; headaches, 100%; jet lag 100%, and for general well being, 80%. 93% of subjects observed some positive results in at least one area.

Bell, undertook a case study using Joudry tapes on a year 2 boy with delayed development. As a result of the program and according to evaluations undertaken by his mother, the experimenter and his teacher, he showed improved social behaviour and began to read. [Bell 1991 ] Hearing Instrument Specialist, Paula Richards studied the effect of Sound Therapy on hearing environmental sounds while listening and found almost no impairment of the ability to hear surrounding noise while the tapes are playing, meaning that it is quite safe to use Sound Therapy during daily activities. [Richards 2001 ]

The portable program Sound Therapy was adapted for cassette tape in the 1980s by Patricia Joudry and Rafaele Joudry, authors of Sound Therapy: Music to Recharge Your Brain and Triumph Over Tinnitus. This meant that thousands of people who did not have access or time to attend the lengthy and costly clinic process could now use the therapy during daily activities. Long term use brought to light more benefits in the areas of sleep, improved energy, reduced stress, relief of tinnitus, improved sound differentiation and in some cases better hearing.

Interestingly, the only studies to examine the effect on hearing and ear related problems were the ones using the portable method. It was only with the advent of the portable method that the effectiveness of Sound Therapy for hearing disorders became apparent, as it usually requires long term treatment to see effect in these areas. These studies however were not rigorously controlled and further research is needed to explore the anecdotal evidence which points to many incidences of improved hearing, reduction in tinnitus, improved ability to differentiate sound in a noisy environment, recovery from recurrent and intermittent ear blockage problems, infections, excess wax production and ear related balance disorders.

PART 2Auditory Neurology That May Support The Tomatis Theory and other Auditory Intervention Techniques. By: George B. Richards, PhD

Call it sound therapy, auditory training or auditory intervention techniques; these therapy approaches have been the focus for investigation into many types of auditory processing disorders through out the world in prestigious institutions of higher learning by leading investigators.

Dr. Tomatis had a rather radical view of the transmission scheme that is 180 degrees out of phase from the traditional viewpoint. He believed that through a negative feedback loop originating at the level of the endolyph, hydraulic pressure was being applied to the ossicles along with middle ear muscle activity as a constant dampening and tuning of the tympanic membrane. The tympanic membrane collected the sound and transmitted it to the organ of Corti via the bony sulcus. Tomatis thus concluded it was the role of the middle ear to regulate sound transmission and provide a buffer for the shearing force required for audition. The human ear must maintain an optimal micro-homeostasis by limiting destructive shearing of the hair cells. Tomatis further believed that it was the middle ear muscles, which control high-frequency audition and have a significant role in cortical charging.

[Figure 1]

Dr. Stephen Porges, at the University of Maryland [USA] working with children with autism and other related disorders, has focused on the two muscles of the middle ear. Porges states that the same nerves that control vocalization, facial expression, heart rate and breathing, innervate the tensor tympani and stapedius muscles. He points out that when the human organism is in a state of fear or high anxiety, the middle ear muscles loose the ability to diminish low-frequency sounds and attending to the higher frequencies of speech is thus impaired. Porges has developed an intervention protocol similar to the Tomatis method using filtered music to exercise the middle ear muscles along with whole body relaxation techniques to restore integrity to the middle ear muscle function and has reported improvements in communication skills, handwriting, balance and coordination, sensory processing, visual skill and sleep patterns. [Porges, 2003]

The research of Rideout and Laubach at Ursinus College in Collegeville, Pennsylvania required eight students to perform spatial-reasoning tasks before and after listening to a Mozart piano sonata. EEG recordings were made in each condition and an interesting correlation was observed. The music condition dramatically increased brain wave activity along with a significant increase in spatial-reasoning performance. [Rideout and Laubach 1997]. Musical perception occurs in the right hemisphere of the brain, which is the same side of the brain that is involved with spatial analysis. [Roederer]

Dr. John Hughes, a neurologist at the University of Illinois Medical Center in Chicago found that music that regularly repeats every 20 to 30 seconds, just as most of Mozart’s compositions do, trigger the strongest brain activity. Dr. Hughes studied the effects of listing to Mozart on 36 subjects with severe epileptic seizures and found an outstanding 29 out of the 36 patients showed significant improvement by having fewer seizures of less intensity. [Hughes, John 1998]

Neurobiologist Gordon Shaw of the University of California at Los Angeles using MRI studies to chart the brain wave activity of individuals listening to different types of music found that only Mozart activated areas of the brain that process fine motor coordination, vision and other higher thought processing regions. [Rauscher, Shaw and Ky, 1995]

Dr. Ingmar Klochoff of Uppsala, Sweden, describes a psychosomatic syndrome, known as the tensor tympani syndrome and is caused by increased psychic tension due to mental stress. There are individuals who do not have a constant impedance of the middle ear. The conclusion for this irregularity was spontaneous tonic tensor tympani muscle activity. The symptoms of this syndrome are often a fullness, tinnitus and dysacusis with a high relation to tension headache and vertigo. This syndrome does not in its self cause hearing loss; however, persons with this syndrome complain of difficulties in understanding what people say. This psychosomatic syndrome is likely to be caused by an inability to attend or concentrate caused by the ever-present rise in psychic tension. [Klochoff 1979]

[Figure 2]

The Centrifugal Pathways are where things start to get interesting. We all struggled with the afferent or input pathways and learned how things got to the brain, but it was that efferent or feed back system that always seemed to be so elusive and not very well understood. The efferent nerves run close to, but not within, the same tracts, as do the afferent nerves. The Superior Olivary Complex is the region of the brainstem where efferent neurons arise and have their point of origin, but are not within the afferent nuclei. It is this system that is responsible for the auditory reflex activities of the stapedius and the tensor tympanic muscles. Traditionally we have been taught that the contraction of these muscles causes the ossicles to become less efficient sound transmitters to the labyrinth, thus protecting the delicate hair cell structure.

[Figure 3]

Unorthodox theories view this reflexive activity to be a tuning system that is continually monitoring the tension being applied to the tympanic membrane and providing protection to the hair cells from superatheshold stimuli.

The auditory efferent system is also feeding information back to the contractile outer hair cells pulling the tectorial membrane into the afferent inner hair causing a mechanical fine tuning effect as in attention and sound localization.

[Figure 4]

These unorthodox theories have merit; in that a true feedback system would have a continuous flow of information that provides maximum tone to the middle ear muscles. Just like an arm or a leg that does not become completely limp when not in use, but maintains a proper tone all of the time, unless injured. This is one of the main theories of the Sound Therapy; that it will restore tone to the middle ear muscle system and in turn tunes up the entire auditory system, which is responsible for 85% of ongoing cortical activity

The system is also very global at a cortical level, sending information to the somatic and automatic nervous system. These more global responses are responsible for feelings of sadness, happiness, anxiety, flight and fight and a host of other visceral responses. It is the ears’ involvement with the X cranial nerve or the vagus nerve [some times referred to as the wandering nerve] that innervates the bronchi and heart going through the diaphragm and on to the entire viscera including the esophagus to the anus. Very simply put, “We therefore have a system in which reflexes can be established at many levels, and in which the cortex controls the reflexes through descending influences..”[Pickles 1988] ]

Through over stimulation, sickness and disease, drug therapies and other oxidative stress, the integrity of the afferent and efferent nervous systems is compromised, with loss of muscle tone and synchrony in the synaptic firing order. This compromise manifests itself in myriad of symptomatic maladies, such as hearing loss, tinnitus, loss of balance and coordination, loss of attention, inability to hear and understand in the presence of background noise, fatigue, tiredness, headaches, anxiety, depression and on and on. So when damage occurs to this delicate feed back system, the homeostasis of the entire organism is compromised. Thus is appears through highly organized temporal stimuli [classical music], which has undergone high band pass filtration, a restoration of aural muscle tone and synaptic firing order provides better cortical processing. Better cortical processing corrects a myriad of problems ranging from: anxiety relief, better hearing, tinnitus control, better balance and coordination, to: feelings of happiness and well being.

It seems that it is the reestablishing of the ability to listen to the higher frequency that is responsible for repairing and reorganizing cortical pathways. The energy levels coming in from the high frequency areas are more intense than for the lower frequencies. Dr. Tomatis calls the high harmonics the “charging sounds” while he describes the lower frequencies as the “discharging sounds”. The lower frequencies supply inadequate energy to the cortex and may even exhaust the individual. [Weeks]

This presentation’s purpose is to suggest some non-invasive treatment recommendations and the studies that support their potential for tinnitus relief.

We will discuss types of treatments and studies conducted on tinnitus patients along with specific supplements and their levels

Literature, journals and the Internet are overflowing with data regarding antioxidant effects on just about every subject imaginable. When we began to research statements lauding the antioxidants and help for tinnitus, there was no shortage of information.

After wading through test studies and analysis, I have attempted to pick out those studies with the most validity and relevance to our topic here today.

Typically the medical profession has prescribed little help for tinnitus sufferers over the years. Most often antidepressants or tranquilizers were used simply to ease anxiety. But on the extensive list of drugs which create or increase tinnitus, these types of drugs rank pretty high. The side effects were helpful, but did not address relief of the total problem. Most often patients were told they would “Just have to live with it”. That is a tough call when it affects their entire life.

Treatments of every type imaginable have been suggested over time.

Recent information supplied to the 18th Annual Meeting of the International Tinnitus Forum in 2000 by Dr. Michael Seidman discussed intravenous treatments under consideration including caroverine. Also discussed was memantine, which is delivered locally to the cochlea, as well as catheter-delivered infusion of magnesium sulfate to the round window. Although these treatments showed some tinnitus improvement, emphasis was made that the treatment of tinnitus through transtympanic injections is not only invasive, but entails potential risk of damaging the hearing mechanisms. [Seidman, 2000] A risk that the majority of hearing health care professionals choose to avoid, like the plague.

The total problem is that tinnitus is very complex in that it creates a vicious cycle for the patient to overcome. The sufferers get stressed from the continuous noise, the inability to sleep and rest, the resulting eating problems, increased anxiety along with depression. All these factors continue to increase the tinnitus and the cycle grows more intense and more vicious.

Treatment factors need to be addressed which involve all of the aspects that accompany the noise of tinnitus.

The antioxidant theory that free radicals in the ear cells and nerves, which were created by noise and stress, can be either completely or partially cured is an extensive subject all in itself.

Kopke et al noted that noise over exposure leads to the development of reactive oxygen species in the cochlea, i.e. [oxidative stress]. The reactive oxygen steals molecules from the healthy outer hair cell [OHC]. These molecules are normally used to support its healthy functioning. Noise over exposure over works the OHC causing the free radicals to release and prevent the cell from replenishing critical nutrients causing the once healthy cell to go into a death cycle. This is why many researchers believe the damaged OHC can be treated with antioxidants before the death cycle reaches a point of no return. [Wolgemuth, 2000]

I will attempt to address the combination of supplements, which we feel are best able to assist with this oxidative stress damage and assist in tinnitus relief; and even in some cases, better hearing.

The first recommendation accompanying all studies is to suggest that patients avoid alcohol, smoking, caffeine and reduce their salt intake. Since this treatment pattern is suggested by doctors for a myriad of ailments and not observed by their patients for any of them, the recommendation of supplements is more widely accepted. After all, we modern, busy people want the perfect pill that will remedy everything that ails us.

The basis of the program dealing with supplements is the inclusion of not just one element, but the combination of Ginkgo Biloba, Garlic, Zinc and Vitamin A.

Ginkgo Biloba: Studies are ongoing and have been in progress for many years relating to use of ginkgo biloba associated with tinnitus as well as hearing problems. Studies have been going on in France, Italy, Germany, Denmark as well as the U.S.A.; and you are all certain to be aware of Jastreboff’s studies with this herbal supplement. [Hazell, 1990] [Jastreboff, 1997]

The German Commission E, who is considered the world’s most knowledgeable body on herbal medicines, recommends EGb 761 [ginkgo biloba] for the treatment of tinnitus. [Bumenthal, Busse, Goldberg, 1998]

There have been 19 clinical trials in Germany investigating the effects of tinnitus treatment with EGb 761. Investigations of prognostic factors revealed that short-standing disorders have a better prognosis; so better results can be expected from early-onset treatment. [Holstein, 2001]

A French multicenter randomized double-blind drug vs. placebo study of the treatment of tinnitus with [EGb 761] extract was very positive. Ten ENT specialists treated 103 tinnitus outpatients during a 13-month treatment period. They summarized that the [EGb 761] extract treatment improved the condition of all the tinnitus patients, irrespective of the prognostic factor. [Meyer, 1986]

A pharmacologic study in Denmark attributes that the therapeutic effect of ginkgo is based on several active constituents that have vasoactive and free radical scavenging properties. The Danish study also found ginkgo biloba to have a very tolerable side effect profile. [Soholm, 1998]

Garlic is lesser known, but not less valuable. Stress is a significant factor in increasing tinnitus noise levels. The modern use of garlic has focused on its ability to reduce stress, reduce cholesterol and regulate blood pressure. A side effect of reducing cholesterol and blood pressure is reducing the volume of noise produced by tinnitus.

The majority of studies show that the positive effects of garlic are those that delivered a sufficient dosage of allicin. Since allicin is the component responsible for the distinctive “ODOR” of garlic we have all come to know and love, manufacturers have developed methods of concentrating another component in garlic, alliin [which is odorless], which is then converted to allicin in the body. [Angerstein, 1995]

Zinc: Studies on zinc and hearing have evolved valuable insight. In 2003, a Turkish placebo-controlled study with tinnitus patients was very successful. Researchers Arda et al, measured blood zinc levels at the beginning of the study. They found that 31% of the subjects suffering tinnitus had lower-than-normal-zinc levels. In the same research group, 82% of the tinnitus sufferers reported a significant decrease in tinnitus severity. [Arda, 2003]

A Japanese study of 121 tinnitus patients suggested a benefit from zinc supplementation. This same investigation suggested it was possible to identify tinnitus patients by measuring serum zinc levels; thus aiding in the overall treatment. [Ochi, 1997]

An important note on Zinc is that large doses can be toxic and should be recommended at less than 40 mg per day.

Finally, Vitamin A: A New York Otorhinolaryngologist, M. J. Lobel, was one of the first to demonstrate in 1949 that vitamin A is useful in treating human hearing loss and tinnitus. Between 1941 and 51, five experimental research studies were conducted into the correlation between the ear and vitamin A. Authors concluded vitamin A was a valuable therapeutic agent in the treatment of deafness and tinnitus. [Lobel, 1951]

Identical trials with 103 patients in 1952 by G. Nager concluded that vitamin A did accomplish an improvement in pure-tone hearing, improvement in speech perception and reduction of accompanying tinnitus. [Nager, 1952]

It is important to note that vitamin A can be toxic in large amounts [over 50,000 I.U. per day] and should be consumed in the form of beta carotine, which the body then converts to vitamin A. [Diesel, 2002]

The trial period in the studies and product literature ranges between 60 to 120 days to determine if any result will be obtained. In many studies, extended trials gave even better results. The majority of recommendations for trial periods of the supplements were 90 days.

Most of these supplements include little or no side effects. As with any patient who is taking medications, they should be informed to check with their physician for any contraindications. However, caution must be exercised to warn patients who might be taking agents for blood-thinning such as coumadin or warfarin to check with their primary physician before taking Ginkgo Biloba.

Additionally, Ginkgo Biloba should be discontinued two weeks prior to any surgical procedure.

Of course if any of your 60 to 80 year old patients are pregnant, they should also check with their doctor.

Futuristic scientific research at Harvard Medical School involved reproducing mouse embryonic stem cells inculture that resemble sensory hair cells in the inner ear. These cells were transplanted into developing ears of chickens and appeared to be very similar to the chicken hair cells surrounding them. This technology may be used to treat disorders primarily due to cell degeneration, including hearing loss. [Cunningham, 2003] But not in the near future.

In summary, areas presented here today are non-intrusive methods that give some level of relief to most tinnitus sufferers.

In our practice, we recommend the combination of Sound Therapy and antioxidant supplements. This synergistic combination allows hearing health care professionals to offer an alternative path for their patients to follow in an effort to alleviate tinnitus suffering.

PRODUCT RECOMMENDATIONS by Rafaele Joudry

Sound Therapy International recommends a combination of Feroxin and Revenol in combination with the Sound Therapy program. Feroxin provides a wide range of at least 60 minerals in a colloidal [liquid] form, derived from a natural source. These minerals assist with a wide range of body and brain functions, assisting the liver to detox so the body can more effectively utilize other nutrients.

Revenol is a powerful antioxidant formula containing several of the most powerful and effective natural antioxidants. The first generation, vitamins A, C and E will work for three hours in the body. The second generation found in grape seed extract and pine bark extract and Ginkgo biloba will last two to three times longer. Third generation anti oxidants, [circuminoids] have now been discovered and will last for up to three days, cleaning your body of free radicals.